Editorial: The new DWI: Driving while ill

Monday

Feb 25, 2008 at 12:01 AMFeb 25, 2008 at 3:35 AM

Should a patient with a broken arm be banned from driving? Certainly there’s no way she can keep two hands on the wheel. How about one with high blood pressure? He could have a stroke behind the wheel. Sound absurd? A proposal before the state Legislature would put Massachusetts doctors in the position of making just such decisions.

The Herald News

Should a patient with a broken arm be banned from driving? Certainly there’s no way she can keep two hands on the wheel.

How about one with high blood pressure? He could have a stroke behind the wheel.
Clinical depression can be very distracting. Better take the keys away; he can hitch a ride to his therapy sessions.

Sound absurd?

A proposal before the state Legislature would put Massachusetts doctors in the position of making just such decisions.

Rep. Kay Khan, D-Newton, filed a bill that would require physicians to report to state authorities any patient older than 16 whose medical condition might impair his or her ability to drive safely. The proposal provides some competition to a bill that aims to weed out bad drivers on the basis of age, not health. Sen. Brian Joyce’s plan would require regular tests for all drivers beyond the age of 85. Legislators have been working on the proposal in committee for two years.

Everyone wants safer roads, and most recognize that injured or seriously ill drivers could potentially present a hazard. As well-intentioned as Kahn’s proposal may be, legislators should dismiss it out of hand.

First and foremost, tattling on patients is simply not a doctor’s job. Physicians exist to help people, to treat their ills and get them back on the road to recovery. It should not be their responsibility to decide whether to report patients to the government. Their job is difficult enough without being forced to spy for Big Brother.

The resulting erosion in the trust between patient and doctor could prevent people from seeking medical treatment when they need it, for fear the government will deem their migraines a hazard to other drivers. With the skyrocketing cost of medical care already keeping patients away, the last thing people need is another reason not to go to the doctor.

There is also the violation of doctor-patient confidentiality, which Khan acknowledges but defends. She said her proposal would not violate the federal Health Insurance Portability and Accountability Act — which guarantees patient confidentiality — because only the Registry of Motor Vehicles would be told. By that rationale, giving nuclear secrets to Iran wouldn’t be treason because only one country would be told.

Confidential means secret and private. If the Registry finds out, the information, by definition, ceases to be confidential. HIPAA exists for a reason: To protect patients from having their private medical information used against them. While Khan inserted language protecting doctors from liability, there’s no way she can protect patients against the violation of their HIPAA rights.

Still, the Legislature does need to take action to make the roads safer. Joyce’s bill is a better approach and should be the basis for a new law. While some may claim age discrimination, few could argue that as one ages, motor skills decline and reaction times slow. Requiring driving tests for the elderly is a reasonable and necessary limit on one’s rights akin to restrictions on teen driving, also imposed on the basis of age.

Joyce’s bill should be strengthened, however. As currently written, it is little more than feel-good legislation, as it only applies to the few people who survive well beyond the expected lifespan of a human being. Lowering the age would have a more significant impact on driving safety. Legislators could index the driving test age with the age at which people begin receiving Social Security, removing the "arbitrary" nature of choosing an age, for which Khan has criticized Joyce.

While legislators likely fear a backlash from elderly voters, requiring driving tests for aging drivers is prudent and responsible. Legislators are just going to have to take that chance. The elderly will understand.

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